The forgotten mosquito

I have this caricature in my head showing lawmakers, other government officials, health experts, big pharma, worried parents and other persons of interest exchanging barbs at a Senate hearing over the antidengue vaccination program that went awry. They are at one another’s throat over the what, where, who, when, why, how, and how much.

Separately, in another box of the cartoon, are deadly dengue mosquitoes in a huddle and plotting their next biting spree that would spread the virus and cause illness and death. “They are not talking about us,” the head mosquito tells the swarm.

The Senate inquiry into the Dengvaxia vaccine administered to hundreds of thousands of schoolchildren and its possible ill effects on the seronegative ones (those who have not been exposed to the dengue virus) is not quite over. Neither are the outcry, the blame-throwing, and the finger-pointing. Fears have not been assuaged. The staggering amount of money spent for the vaccine from French pharmaceutical giant Sanofi Pasteur has yet to be fully recovered.

It is all about the vaccine, the money gone down the drain, and the vaccinated children on whom the vaccine might not work and which might even make them sicker if dengue strikes. All but forgotten is the female dengue mosquito that transmits the virus through its bite.

About a dozen vaccinated seronegative children have reportedly died but their deaths have not been conclusively and solely attributed to Dengvaxia itself, but to some preexisting health condition. And if they died because of dengue itself, then the vaccine did not work for them (as expected) and made their condition worse?

In the case of the seropositive ones who had been previously exposed to dengue, the group supposed to benefit from Dengvaxia’s protection if at all, were there deaths because of dengue? If there were, this means Dengvaxia did not protect them at all?

Questions arose because of Sanofi’s own announcement late last year that Dengvaxia might (or would?) cause some adverse effects on seronegative children who were vaccinated. What parent would not raise a howl? And there were questions, too, on why Sanofi’s announcement was phrased in an alarming way — and was it therefore a case of “lost in translation” or a communication fiasco? I have always been wary of big pharma.

At the latest Senate hearing former health secretary Enrique Ona said that were he in charge in 2016 he would not have allowed immunization on such a massive scale. He cited a 2015 New England Journal of Medicine editorial titled “A candidate dengue vaccine walks a tightrope.” And so the onus was on his successor, Janette Garin, who implemented the P3.5-billion program in 2016.

After Sanofi’s announcement last month, the vaccination program was stopped. But the question remains: What prompted the Department of Health to hurry with the immunization in 2016? The then approaching 2016 national elections is now being factored in by former health secretary Paulyn Ubial, who has been replaced by Francisco Duque, himself a health secretary several presidents ago. Duque stays cool and invokes “prudence and due diligence” where the lives of children are concerned.

Question: Had massive immunization (which was there to offer) not been implemented, and there happened to be a massive dengue outbreak at that time, with casualties in its wake, would the sin of omission or indecisiveness be cited against the incumbents then? As in, many lives could have been saved, illness and death could have been prevented, all the expense could have been worth it.

But that was not the case. The immunization program pushed through and a new scenario came into view: possible severe dengue cases among the seronegatives who had Dengvaxia injections.

For those in charge, it’s damned if you didn’t, damned if you did. Still, there were lessons learned.

Meanwhile, the female aedes aegypti mosquito rules. It is the species of mosquito that carries dengue, chikungunya and yellow fever viruses.  The mosquito bites a dengue-infected person, becomes a carrier, and when it again bites, the virus is transmitted, and so on and so forth. Anything being done in mosquito country?

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